1) How often do you drink anything containing alcohol?
Never (0 points)
Monthly or less (1 point)
2 to 4 times a month (2 points)
2 to 3 times a week (3 points)
4 or more times a week (4 points)
2) How many alcohol drinks do you have on a typical day?
1 or 2 (0 points)
3 or 4 (1 point)
5 or 6 (2 points)
7 to 9 (3 points)
10 or more (4 points)
3) How often do you have 5 or more drinks on one occasion?
Never (0 points)
Less than monthly (1 point)
Monthly (2 points)
Weekly (3 points)
Daily or almost daily (4 points)
4) How often in the last year were not able to stop drinking once you had started?
Never (0 points)
Less than monthly (1 point)
Monthly (2 points)
Weekly (3 points)
Daily or almost daily (4 points)
5) How often in the last year have not been able to do what was normally expected of you because of drinking?
Never (0 points)
Less than monthly (1 point)
Monthly (2 points)
Weekly (3 points)
Daily or almost daily (4 points)
6) How often during the last year have you needed a drink in the morning to get going after a night of heavy drinking?
Never (0 points)
Less than monthly (1 point)
Monthly (2 points)
Weekly (3 points)
Daily or almost daily (4 points)
7) How often during the last year have you felt guilty or remorsefull after drinking?
Never (0 points)
Less than monthly (1 point)
Monthly (2 points)
Weekly (3 points)
Daily or almost daily (4 points)
8) How often during the last year have you forgotten what happened the night before because of drinking?
Never (0 points)
Less than monthly (1 point)
Monthly (2 points)
Weekly (3 points)
Daily or almost daily (4 points)
9) Have you or someone else been injured as a result of your drinking?
No (0 points)
Yes but not in the last year (2 points)
Yes, during the last year (4 points)
10) Has a relative, friend, or health care worker been concerned about your drinking or suggested you cut back?
No (0 points)
Yes but not in the last year (2 points)
Yes, during the last year (4 points)